Hunger Confronts Bigger Issue

In The Developing World, Obesity Is A Greater Threat Than Malnutrition

September 28, 2003|By Barry Popkin, Special to the Sentinel

The world's nutrition problems have changed dramatically in recent years in a way most Americans probably have difficulty fathoming:

In most of the developing world, obesity is now a larger problem than malnutrition.

Here's why.

If you lived in a village or urban-slum area in China or Mexico or Egypt 25 years ago, you were unlikely to have electricity or pumped water. You certainly did not know what television was; you walked to work or rode a cart linked to an animal; and your work was physically very strenuous.

Your diet was monotonous and was based on rice or wheat products with possibly a few vegetables and/or beans, and few condiments and no cooking oil.

If you go back to those same villages or slum areas today, people have electricity and television, their transportation is often via a bus or gas-powered vehicle, and their work utilizes some type of gas-powered engine. And their diet includes a lot of vegetable oil and some processed-food products that contain added sugar. Some animal-source foods -- be they chicken, beef, pork, goat or fish products -- are consumed, as well.

This revolution in lifestyle does not mean these people live as well as we do in the United States. But it has brought a sea change in the way people in the developing world live, work and eat. And with that has come much less physical activity at work, leisure and transportation. And their diets are much richer in fat and are consequently more energy-dense. They often have replaced healthful water or other beverages with calorically sweetened beverages. And they are often obese.

In fact, the levels of obesity for men and women in many developing countries as diverse as Egypt and Mexico and South Africa are as high as those found in the United States.

In the United States, 64 percent of women were found to be overweight or obese in our latest 1999-2000 survey. In contrast, in Mexico, 60 percent of women were overweight or obese. In South Africa among the poorest black women, 58 percent were overweight or obese, and, in the same category in Egypt, 69 percent of the women who were overweight.

Further, the annual increase in the percentage of adults who are overweight is growing several times as fast in many of these countries. Every year, about a half-percentage point of all American adult men and 0.39 percentage points of U.S. women become overweight or obese, while in Brazil, China, Mexico, Morocco and Thailand, the annual rates of increase are higher.

The rate of increase is sixfold that for Mexican women compared with U.S. women. Also the rate of increase is much higher in China, Morocco and Brazil -- countries for which we have comparable nationally representative surveys at two or more points of time.

Another way of looking at this is to look at the map of countries where we have nationally representative survey data on overweight status for women. You can see that there are more women overweight in a number of other countries, and all of these are outside what we term the higher-income world. There is a similar trend among men.

What about hunger? Clearly, world starvation and hunger have not disappeared. In Haiti, South Asia and sub-Saharan Africa, hunger is still a major problem. However, at one time, there was not a country in the developing world where overweight and obesity were greater than hunger and undernutrition.

Today we find from one of my studies in process that, of 38 countries from the developing world for which we have nationally representative data, in all except four there are more overweight problems and obesity among adult women than there are those dealing with being underweight.

Worldwide today, the number of obese people far exceeds the number of undernourished ones. This is a startling development that requires some explanation.

What is happening to the diets of the world?

Again, imagine how bland and healthful the diets of Mexicans might have been. When at their best, rice, beans, tortillas and a little citrus juice produce a well-balanced diet that is low in oil and sugar and high in fiber and many critical nutrients.

But the modern food-processing industry and added consumer income, urbanization, improved transportation, TV, food advertising and other changes have led to diets that are much higher in fat and added sugar.

Healthful fruits and vegetables are not increasing much in people's diets, while they are more likely to consume sugared water in some soft drinks or fruit drinks and add a lot of vegetable oil to their dishes. And they consume more meat.

A revolution has occurred. For instance, in the early 1980s, no adults in China consumed what we call a high-fat diet with more than 30 percent of their calories from fat. Today, over half of Chinese adults consume such a diet. In China, dietary shifts are very quickly occurring. Rice and flour intake is down, and animal-source foods such as pork and poultry and fish are way up, and the steepest increase is in the use of edible vegetable oils for cooking.